髂静脉支架置入术时存在活动性静脉下肢溃疡的患者需要更多的再次手术。
Patients with active venous leg ulcers at the time of iliac vein stenting require more reoperations.
机构信息
Icahn School of Medicine at Mount Sinai, New York, NY.
Icahn School of Medicine at Mount Sinai, New York, NY.
出版信息
J Vasc Surg Venous Lymphat Disord. 2022 Nov;10(6):1304-1309. doi: 10.1016/j.jvsv.2022.05.002. Epub 2022 Jun 30.
OBJECTIVE
An active venous leg ulcer (VLU) caused by lower extremity venous insufficiency is challenging to treat and will often recur after initially healing. In the present study, we compared the symptomatic outcomes and need for reoperation after iliac vein stenting (IVS) in patients with an active VLU (VLU+) and those without an active VLU (VLU-).
METHODS
A single-institution database of patients with chronic venous outflow obstruction who underwent IVS from August 2011 to June 2021 was analyzed. Symptoms were quantified using the venous clinical severity score. The patients were divided into two cohorts: those with (VLU+) and without (VLU-) VLUs.
RESULTS
A total of 872 patients (71 VLU+ and 801 VLU-) were identified. Many of the demographics and comorbidities differed between the two cohorts, and these variables were included in the multivariable analysis. On univariate analysis, the VLU+ cohort was more likely to need a major reoperation (odds ratio, 1.94; 95% confidence interval, 1.01-3.52; P = .036). However, on multivariable analysis, the difference was not statistically significant (odds ratio, 1.17; 95% confidence interval, 0.55-2.40; P = .667). Additionally, the VLU+ cohort required a significantly greater mean total of reoperations (1.4 vs 1.0; P = .006) than the VLU- cohort. Comparatively, for patients who underwent at least one reoperation, the difference in the mean total number of reoperations was even greater for the VLU+ cohort (2.6 vs 1.8; P = .001). The results from the Kaplan-Meier log-rank test revealed no differences in the reintervention-free survival time (P = .980). Both cohorts experienced a durable mean reduction in the venous clinical severity score. The ulcer healing rates for the VLU+ cohort at 6, 12, 24, and 36 months were 38%, 47%, 52%, and 59%, respectively. The ulcer recurrence rates for the VLU+ cohort were 4%, 10%, 19%, and 30% at 6, 12, 24, and 36 months, respectively, with a median time to recurrence of 1.2 years.
CONCLUSIONS
Patients with active VLUs who underwent a first reintervention after initial IVS, on average, required an additional reintervention.
目的
下肢静脉功能不全导致的活动性静脉溃疡（VLU）治疗具有挑战性，且在初次愈合后常复发。本研究比较了有（VLU+）和无（VLU-）活动性 VLU 的患者行髂静脉支架置入术（IVS）后的症状结局和再次手术需求。
方法
分析了 2011 年 8 月至 2021 年 6 月期间行 IVS 的慢性静脉流出道阻塞患者的单机构数据库。采用静脉临床严重程度评分（venous clinical severity score）量化症状。将患者分为两组：有 VLU（VLU+）和无 VLU（VLU-）。
结果
共纳入 872 例患者（71 例 VLU+和 801 例 VLU-）。两组患者的许多人口统计学和合并症均存在差异，这些变量被纳入多变量分析。单因素分析显示，VLU+组更可能需要进行主要再次手术（比值比，1.94；95%置信区间，1.01-3.52；P=0.036）。然而，多变量分析显示差异无统计学意义（比值比，1.17；95%置信区间，0.55-2.40；P=0.667）。此外，VLU+组需要进行的总再手术次数明显多于 VLU-组（1.4 次比 1.0 次；P=0.006）。相比之下，对于至少进行了一次再次手术的患者，VLU+组的总再手术次数差异更大（2.6 次比 1.8 次；P=0.001）。Kaplan-Meier 对数秩检验结果显示，两组患者的再干预无失败生存时间无差异（P=0.980）。两组患者的静脉临床严重程度评分均有持续的平均降低。VLU+组在 6、12、24 和 36 个月时的溃疡愈合率分别为 38%、47%、52%和 59%。VLU+组在 6、12、24 和 36 个月时的溃疡复发率分别为 4%、10%、19%和 30%，中位复发时间为 1.2 年。
结论
初次 IVS 后行首次再次干预的活动性 VLU 患者平均需要进行额外的再次干预。
Zotero 插件